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Objectives: In presence of lung cancer, the additional impact of comorbidity on survival is often neglected, although comorbidities are likely to be prevalent. Our study examines the comorbidity profile and the impact of distinct conditions on survival in German lung cancer patients., Material and Methods: We investigated claims data from a large nationwide statutory health insurance fund of 16,202 patients initially diagnosed with lung cancer in 2009. We calculated the prevalence of comorbidities grouped according to an extension of the Elixhauser Comorbidity Index (EI). Effects of distinct comorbidities on 5-year survival were examined using multivariate Cox proportional hazards models, adjusted for sex, age and metastases at baseline. All analyses were stratified by initial lung cancer-related treatment regimen (Surgery, Chemotherapy/Radiotherapy, No treatment). Findings were visualized in the form of a comorbidome., Results: Our study population was predominantly male (70.6%) with a mean age of 68.6 years, and a mean EI score of 3.94. Patients without treatment were older (74.4 years), and their comorbidity burden was higher (mean EI = 4.59). Median survival varied by subgroup (Surgery: 24.4 months, Chemotherapy/Radiotherapy: 8.8 months, No treatment: 2.0 months), and so did the comorbidity profile and the impact of distinct conditions on survival. Generally, the effect of comorbidities on survival was detrimental and the negative association was most pronounced for 'Weight Loss' and' Paralysis'. In contrast, 'Lipid Metabolism Disorders' and 'Obesity' were positively associated with survival. Noteworthily, highly prevalent conditions tended not to show any significant association., Conclusion: We found specific comorbidity profiles within the distinct treatment regimens. Moreover, there were negative but also some positive associations with survival, and the strength of these effects varied by stratum. Particularly the positive effects of 'Obesity" and 'Lipid Metabolism Disorders' which were robust across strata need to be further investigated to elucidate potential biomedical explanations., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. Its appearance as a primary lung tumor is extremely rare. The cell origin of MFH remains controversial. The treatment of choice for MFH is surgical resection, while the role of chemo- and radiotherapy remains unclear., Methods: A retrospective analysis of 5 patients operated on for primary MFH in the Department of Thoracic Surgery of the Medical University in Gdansk between 1990 and 2000 was performed., Results: Out of approximately 2000 patients operated on for primary malignant lung tumors, five (0.25 %) had MFH. The mean age of the 4 men and 1 woman was 62 years. In all cases radical resection was performed without adjuvant chemo- or radiotherapy. Four patients died within 2 - 7 months after the operation, three of them from distant metastases. The follow-up of one patient is not available. One patient is alive 11 years after the operation., Conclusion: Although surgical resection of MFH is the treatment of choice in MFH, the results are unsatisfactory.

Background: Sentinel lymph node identification has been tested in lung cancer patients with conflicting results. The present study was designed to assess the sensitivity, negative predictive value, and accuracy of intraoperative sentinel lymph node mapping by means of a radio-guided method in patients with nonsmall cell lung cancer to find the most appropriate definition of sentinel lymph node and to evaluate the usefulness of different particle sizes of radiocolloid., Methods: One hundred ten patients with clinically N0 nonsmall cell lung cancer were enrolled in the pilot study of intraoperative sentinel node identification. Four quadrants of the peritumoral tissue were injected with 2 mL of 0.5 mCi technetium-99m suspension. Four radiocolloids of different particle size were used. After complete lymphadenectomy, all resected lymph nodes were examined with hematoxylin-eosin staining. All sentinel nodes negative for metastases by routine staining were searched further for metastatic deposits with both serial sections and immunohistochemistry for cytokeratins., Results: The radio-guided method had a high identification rate, a high sensitivity, and a high negative predictive value (100%, 87%, and 93%, respectively) when immunohistochemistry was considered. When standard hematoxylin and eosin staining was applied, sensitivity and negative predictive value of sentinel lymph node labeling was lower (74% and 89%, respectively). No significant differences were found in either the sensitivity or negative predictive value among the colloid solutions of different particle size used in radio labeling, although smaller particles have shown a tendency to produce better results., Conclusions: The radio-guided technique provides efficient sentinel lymph node identification in lung cancer. Further studies are warranted to confirm the clinical utility of this strategy.

Aims: The blue-dye staining method of sentinel lymph node identification in lung cancer patients has been scarcely reported. The study was designed to assess the sensitivity, accuracy and negative predictive value (NPV) of intraoperative sentinel lymph node mapping in patients with non-small cell lung cancer by means of staining with colloid or water solution of blue dye., Patients and Methods: One hundred and ten patients with clinically confirmed NO non-small cell lung cancer were enrolled into prospective study of intraoperative sentinel node identification. Four quadrants of the peritumoral tissue were injected with 4 ml of blue dye. After complete lymphadenectomy, all resected lymph nodes were examined with conventional hematoxylin-eosine staining. All negative sentinel nodes were searched for metastatic deposits with both serial sections and immunohistochemistry for cytokeratines., Results: The blue-dye technique was characterized by unacceptably low sentinel node identification rate (IR) and low sensitivity (27% and 67% respectively). No significant differences were found in either the sensitivity or NPV among the colloid or water solutions of the blue dye applied. Although patent blue (colloid) was superior to water solution of methylene blue in identifying sentinel lymph node (identification rate 36% and 22% respectively) the sensitivity and NPV were lower (63% and 80% for patent blue and 75% and 92% for methylene blue respectively)., Conclusion: The blue-dye staining method of sentinel node identification in non-small cell lung cancer patients is inadequate and should not be recommended for clinical use.

Neoadjuvant chemotherapy before resection is being the standard of care for stage IIIA non-small cell lung cancer in many institutions. The risk of complications in patients undergoing thoracotomy after induction chemotherapy remain controversial. We reviewed our experience. From 1998 to 2003, 29 patients underwent pulmonary resection after induction chemotherapy for advanced non-small cell lung cancer. Pneumonectomies were performed for 16 (55.2%) patients (2 right sleeve pneumonectomy and 1 pneumonectomy with wedge excision of tracheal carina), lobectomies for 11 (37.9%) patients (3 right upper sleeve lobectomy), segmentectomies for 1 (3.45%) patient and explorative thoracotomy for 1 (3.45%) patient. There were 3 (10.3%) postoperative deaths, all after right pneumonectomy; 2 caused by pneumonia of the left lung, 1 caused by pulmonary embolism in patient after re-thoracotomy for hemothorax. The postoperative complications included pneumonia in 2 patients, postoperative bleeding in 2, hemothorax in 1, prolonged intubation in 1, vocal cord paralysis in 2, cardiac arrhythmia in 2, atelectasis in 1 and residual air space in 1, resulting in 41,4% morbidity. Most of complications occurred after right pneumonectomy (45.5%). The mortality of patients who had received induction chemotherapy was higher than that of a comparative group of 1529 who underwent lung resection or only exploration without induction chemotherapy during the same period, and the difference was significant (10.3% vs 4.1%; p = 0.01). Morbidity differences were. not significant (p = 0.94).